经皮椎体后凸成形术治疗老年重度骨质疏松性椎体压缩骨折

目的探讨经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗老年重度骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床疗效。方法回顾分析2009年6月~2012年6月在本院行PKP治疗的59例(70个椎体)椎体后壁完整的重度OVCF患者的临床资料,其中男10例,女49例;年龄63~87岁,平均73.1岁;患椎压缩比66.7%~74.8%,平均70.6%;采用低压渐进式球囊扩张复位法行PKP。对比术前、术后及末次随访时疼痛视觉模拟量表(visual analogue scale,VAS)评分、SF-36健康调查评分、患椎平均高度及局部Cobb角,评价临床疗效。结果 59例患者均顺利完成手术,发生骨水泥椎旁渗漏5例,无其他严重并发症。术后随访1.8~3.4年,平均2.6年。VAS评分术前为(8.3±2.2)分,术后3 d为(2.1±0.7)分,末次随访时为(2.1±0.7)分;SF-36健康调查评分术前(32.7±6.9)分,术后3 d为(43.2±7.1)分,末次随访时为(47.1±6.5)分;患椎高度术前为(8.2±1.4)mm,术后3 d为(12.7±2.3)mm,末次随访时为(11.8±1.6)mm;局部Cobb角术前27.8°±5.3°,术后3 d为18.7°±4.1°,末次随访时为19.6°±4.5°。各组数据术后3 d和末次随访时与术前比较,差异均有统计学意义(P0.05),术后3 d和末次随访时比较差异无统计学意义(P0.05)。结论采用低压渐进式球囊扩张复位法行PKP治疗老年重度OVCF安全、有效。

Percutaneous kyphoplasty for treatment of elderly severe osteoporotic vertebral compression fractures

Objective To evaluate the clinical outcomes of percutaneous kyphoplasty(PKP)for treatment of elderly severe osteoporotic vertebral compression fracture(OVCF). Methods From June 2009 to june 2012, 59 cases(70 vertebral) with severe OVCF were analyzed retrospectively. There were 49 females and 10 males with the mean age of 73.1 years. The average compression rate of the affected vertebral bodies was 70.6%. The thoracolumbar vertebrae were treated with PKP. The balloon was inflated with low pressure and dilated gradually. The visual analog scale(VAS) scores, SF-36 health survey scales scores, the mean vertebra height and the local Cobb's angle were analyzed at pre-and post-operation and final follow-up. Results All the cases went through the operation successfully and safely, except for 5 cases with complication of para-vertebra cement leakage, and no other complication occurred. The cases were followed up for 1.8-3.4 years (mean 2.6 years). The VAS scores were 8.32± 2.15 before operation, 2.07±0.66 at postoperative 3 d and 2.14±0.71 at the final follow-up. The SF-36 health survey scales scores were 32.7±6.9 before operation, 43.2±7.1 at postoperative 3 d and 47.1±6.5 at the final follow-up. The mean heights of the vertebral body were(8.2±1.4) mm before operation, (12.7±2.3) mm at postoperative 3 d and(11.8± 1.6) mm at the final follow-up. The local Cobb's angles were 27.8°±5.3°before operation, 18.7°±4.1° at postoperative 3 d and 19.6°±4.5° at the final follow-up. All the index of postoperative 3 d and the final follow-up compared with those of pre-operation, and the differences were statistically significant (P<0.05). And the difference was not statistically significant between postoperative 3 d and the final follow-up (P>0.05). Conclusion PKP with low pressure progressive dilatation balloon repositioning is safe and effective for severe OVCF.